Method and apparatus for attaching soft tissue to bone

ABSTRACT

A repair system including at least one anchor, screw, or plate with a body and a suture capture element formed in the body for attaching at least one suture to the anchor, screw, or plate. The suture capture element being configured so as to permit the suture to be snared by the suture-capture element after the anchor, screw, or plate has been attached to bone.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims benefit to U.S. Provisional Application Ser. No.61/374,536, filed Aug. 17, 2010, and U.S. Provisional Application Ser.No. 61/443,129, filed Feb. 15, 2011, each of which is herebyincorporated herein in its entirety.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention relates to surgical methods and apparatus in general, andmore particularly to surgical methods and apparatus for attaching softtissue to bone and for reducing and fixing fractured bones.

2. Brief Description of Related Art

In many situations soft tissue may need to be attached (or re-attached)to bone. By way of example but not limitation, a ligament or tendon mayhave been detached from bone as the result of injury and/or accident,and appropriate repair may require re-attaching the ligament or tendonto its host bone. By way of further example but not limitation, somesurgical procedures may require the suspension of soft tissue from anadjacent bone, e.g., a so-called “bladder neck suspension” may involvesuspending portions of the bladder and/or urethra from the pubic bone inorder to address incontinence.

Currently, suture anchors are typically used to attach soft tissue tobone. Such suture anchors generally comprise a body and one or moresutures attached to the body. In use, the body of the suture anchor isdeployed in bone so that the one or more sutures extend out of the bone.The one or more sutures may then be used to secure the soft tissue tothe bone, e.g., by passing the one or more sutures through the softtissue and then knotting the suture so as to hold the soft tissue inposition relative to the bone.

Current suture anchors generally suffer from several disadvantages.First, current suture anchors have their one or more sutures attached tothe suture anchor either at the time of manufacture or in the operatingroom just prior to use. In either case, the one or more sutures areattached to the body of the suture anchor prior to deployment of thesuture anchor in the body. As a result, during surgery, the surgeon isconstrained by the configuration of the suture anchor once it has beendeployed in the body. In other words, with current suture anchorconstructions, the particular anchor body/suture configuration selectedby the surgeon prior to deployment in the bone significantly constrainsthe choices available to the surgeon after the suture anchor has beendeployed in the bone. This can be a significant limitation, since inmany circumstances the surgeon may wish to adjust a procedure inresponse to tissue conditions which may only become apparent after theprocedure has begun.

In addition to the foregoing, it can be difficult and/or inconvenientfor the surgeon to knot the suture when physical access to the surgicalsite is limited, e.g., as in the case of an arthroscopic procedure.

As a result, one object of the present invention is to provide a new andimproved suture anchor for attaching soft tissue to bone which permitsthe surgeon to attach one or more sutures to the body of the sutureanchor after the body of the suture anchor has been deployed in bone,thereby allowing the surgeon to customize the manner in which the softtissue is attached to the bone.

Another object of the present invention is to provide a surgeon with theability to modify a soft tissue repair construct, in part or in whole,without removing any previously-deployed anchors forming part of therepair construct.

And another object of the present invention is to provide a new andimproved suture anchor for attaching soft tissue to bone which permitsthe soft tissue to be attached to the bone without tying a knot in thesuture.

Fracture plates are commonly used to reduce and fix broken bones. Theseplates may be employed in many locations around the body including, butnot limited to the humerus, radius, ulna, femur and tibia. Oftentimessurrounding soft tissue is used to augment the repair. To incorporatesoft tissue into the repair, surgeons will pass surgical suture throughthe soft tissue in a variety of stitching patterns and then secure thesuture to the implant used to fix the fracture in the bone. Currenttechnology allows for surgeons to pass the surgical suture throughcircular holes made along the perimeter of the implant. Traditionally,the suture had to be placed before the implant was secured to the bonebut more recent developments allow suture to be threaded through theholes after the implant is secured to the bone. Nonetheless, allexisting technology is limited to a hole through which suture must bethreaded.

Limitations of this design include the fact that suture may not beremoved easily from the hole after it has been threaded through.Additionally, due to the fact that suture will typically have a curvedneedle attached to its leading end to facilitate suture passing, it isunwise to pass a second or third segment of suture through the same holein the implant as the surgeon may risk damaging the original strand withthe sharp point of the curved needle.

Therefore, there exists a need for an improved method of securingsurgical suture to implants than current technology provides and it isthe objective of this invention to provide that improvement.

SUMMARY OF THE INVENTION

The inventive concepts disclosed herein include a new suture anchorsystem for attaching soft tissue to bone which permits the surgeon toattach one or more sutures to the body of the suture anchor after thebody of the suture anchor has been deployed in bone, thereby allowingthe surgeon to customize the manner in which the soft tissue is attachedto the bone. The inventive concepts disclosed herein provide a surgeonwith the ability to modify a soft tissue repair construct, in part or inwhole, without removing any previously-deployed anchors forming part ofthe repair construct. Furthermore, the present invention permits thesoft tissue to be attached to the bone without tying a knot in thesuture.

In one form of the present invention, there is provided a repair systemcomprising:

at least one anchor, the at least one anchor comprising a body, abone-engaging element attached to the body for securing the body inbone, and a suture-attaching element attached to the body for attachingsuture to the anchor, the suture-attaching element being configured soas to permit suture to be snared by the suture-attaching element afterthe anchor has been deployed in the bone.

In another form of the present invention, there is provided a method forattaching soft tissue to bone, the method comprising:

providing a repair system, the repair system comprising:

at least one anchor, the at least one anchor comprising a body, abone-engaging element attached to the body for securing the body inbone, and a suture-attaching element attached to the body for attachingsuture to the anchor, the suture-attaching element being configured soas to permit suture to be snared by the suture-attaching element afterthe anchor has been deployed in the bone;

deploying the at least one anchor in the bone; and

presenting at least one suture to the at least one anchor so that the atleast one suture is snared by the suture-attaching element, whereby toattach the at least one suture to the at least one anchor.

In another form of the present invention, there is provided a repairsystem comprising:

at least one plate comprising a body and a suture-attaching elementattached to the body for attaching at least one suture to the plate, thesuture-attaching element being configured so as to permit suture to besnared by the suture-attaching element after the plate has been attachedto the bone.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other objects and features of the present invention will bemore fully disclosed or rendered obvious by the following detaileddescription of the invention, which is to be considered together withthe accompanying drawings wherein like numbers refer to like parts, andfurther wherein:

FIG. 1 is a schematic view showing a suture anchor system comprising apilot drill, an anchor, a driver and a suture threader;

FIGS. 2 and 3 are schematic views showing the anchor of the system ofFIG. 1;

FIGS. 4 and 5 are schematic views showing the suture threader of thesystem of FIG. 1;

FIGS. 6-10 are schematic views showing a method of using the system ofFIG. 1;

FIG. 11 is a schematic view of a suture-binding plug which may be usedwith the anchor shown in FIGS. 2 and 3;

FIGS. 12-14 are schematic views of another anchor formed in accordancewith the present invention;

FIGS. 15 and 16 are schematic views of a driver which may be used toinsert the anchor of FIGS. 12-14 in a bone;

FIG. 17 is a schematic view of another suture threader which may be usedin conjunction with the anchor of FIGS. 12-14;

FIGS. 18-20 are schematic views showing a method of using the anchor ofFIGS. 12-14 and the suture threader of FIG. 17;

FIG. 21 is a schematic view of a suture-binding plug which may be usedwith the anchor of FIGS. 12-14;

FIG. 22 is a schematic view of another suture-binding plug which may beused with the anchor of FIGS. 12-14;

FIGS. 23 and 24 are schematic views of another anchor formed inaccordance with the present invention;

FIGS. 25 and 26 are schematic views of another suture threader which maybe used in conjunction with the anchor of FIGS. 23 and 24;

FIG. 26A is a schematic view of another suture threader formed inaccordance with the present invention;

FIGS. 27-29 are schematic views showing a method of using the anchor ofFIGS. 23 and 24 and the suture threader of FIGS. 25 and 26;

FIGS. 30-33 are schematic views illustrating suture receiving mechanismsfor capturing a suture to an anchor in accordance with the presentinvention;

FIGS. 34-36 are schematic views of another suture threader which may beused in accordance with the present invention;

FIG. 37 illustrates examples of various stitching patterns which may beused to capture suture to an anchor;

FIGS. 38-44 are schematic views illustrating suture designs which may beused in accordance with the present invention; and

FIGS. 45-48 are schematic views illustrating a soft tissue graspingmechanism.

FIG. 49 is side views of bone screws provided with a suture captureelement.

FIG. 50 is a sectional side view of a portion of a bone screw having asuture capture element.

FIG. 51 shows additional views of an embodiment of a bone screw providedwith a suture capture element.

FIG. 52 is an isometric view of a bone plate provided with a suturecapture element.

FIG. 53 is a top plan view of the bone plate of FIG. 52.

FIG. 54 is a side elevational view of the bone plate of FIG. 52.

FIG. 55 is a sectional view of the bone plate.

FIG. 56 is a sectional front view of the bone plate.

FIG. 57 is a top plan view of a portion of another embodiment of a boneplate provided with a suture capture window.

FIG. 58 is a side elevational view of the bone plate of FIG. 57.

FIG. 59 is a sectional view of the bone plate of FIG. 57.

FIG. 60 is a sectional view of the bone plate showing a suture loopedaround a peninsula.

FIG. 61 is an enlarged sectional view of another embodiment of a boneplate illustrating a hook member on the undersurface of the peninsula.

FIG. 62 is an enlarged sectional view of another embodiment of a boneplate having a flexible post.

FIG. 63 is an enlarged sectional view of the bone plate of FIG. 62illustrating a suture folded in half thereby creating a loop which maybe snagged by a nose of the peninsula.

FIG. 64 is an enlarged sectional view of the bone plate showing thesuture wrapped around the peninsula with the flexible post securing thesuture in the suture capture window.

FIG. 65 is an enlarged sectional view of the bone plate showing multiplesutures captured by the suture capture window.

FIG. 66 is an enlarged sectional view of the bone plate showing bothhalves of a suture on the same side of the peninsula.

FIG. 67 is an elevational view of a plug positioned on a deploymentdevice.

FIG. 68 is cutaway view of an anchor showing the plug inserted into theanchor prior to deployment.

FIG. 69 is an enlarged sectional view of the anchor illustrating theplug in a deployed condition.

FIG. 70 is an elevational view of a deployment device used to deploy aplug.

FIG. 71 cutaway view of the deployment device of FIG. 70.

FIG. 72 is a front elevational view of another embodiment of a filamentthreader.

FIG. 73 is a side elevational view of the filament threader of FIG. 72.

DETAILED DESCRIPTION OF THE INVENTION

Looking first at FIG. 1, there is shown a suture anchor system 5 formedin accordance with the present invention. Suture anchor system 5generally comprises a pilot drill 10, an anchor 15, a driver 20 and asuture threader 25 carrying a suture 30 therein.

Still looking now at FIG. 1, pilot drill 10 is a conventional pilotdrill of the sort used to form a pilot hole in bone. Pilot drill 10generally comprises a shaft 35 terminating in a distal point 40.

Looking next at FIGS. 1-3, anchor 15 generally comprises a cylindricalbody 45 having a distal end 50 and a proximal end 55. Screw threads 60extend from distal end 50 to proximal end 55. A non-circular (e.g.,hexagonal) bore 65 extends from distal end 50 to proximal end 55.Cylindrical body 45 is substantially rigid.

A hollow nose cone 70 is secured to distal end 50 of cylindrical body45. Hollow nose cone 70 comprises a generally conical shape, with itsbase 75 being secured to distal end 50 of body 45 and with its pointedtip 80 extending distally away from body 45. The hollow interior ofhollow nose cone 70 communicates with the distal end of bore 65 formedin body 45 of anchor 15. Hollow nose cone 70 also comprises a pluralityof slits 85 which divide hollow nose cone 70 into a plurality of fingers90. Slits 85 terminate, at their proximal ends, in enlarged circularopenings 95. Preferably a circumferential surface groove 100 is formedin the outer surface of hollow nose cone 70, with circumferentialsurface groove 100 being aligned with, and communicating with, enlargedcircular openings 95. Fingers 90 of nose cone 70 are formed out of aresilient material, such that (i) the distal ends of fingers 90 normallyreside in a converging position, so as to collectively form pointed tip80 of hollow nose cone 70, and (ii) the distal ends of fingers 90 can beforced radially outwardly, in the manner shown in FIG. 9, as willhereinafter be discussed in further detail.

Looking next at FIG. 1, driver 20 is a conventional torque driver. Moreparticularly, driver 20 comprises a shaft 105 having a non-circular(e.g., hexagonal) cross-section. The non-circular cross-section ofdriver 20 corresponds to the non-circular bore 65 formed in anchor 15,in order that driver 20 may be engaged in bore 65 and used to turnanchor 15, as will hereinafter be discussed in further detail.

Looking next at FIGS. 1, 4 and 5, suture threader 25 generally comprisesa shaft 110 having a distal end 115 and a proximal end 120. A lumen 125extends along the length of shaft 110. Adjacent to distal end 115 ofshaft 110, the side wall of lumen 125 preferably extends transverse tothe longitudinal axis of shaft 110, e.g., as shown at 130. Transversesurface 130 serves to direct a loop of suture passing down lumen 125transversely out of the distal end of shaft 110 when the sutureencounters transverse surface 130.

More particularly, and still looking now at FIGS. 1, 4 and 5, suturethreader 25 is intended to carry a suture 30 within lumen 125 of thesuture threader. Suture 30 is intended to be “doubled over” within lumen125 so that its distal loop 135 sits just proximal to transverse surface130, and so that its two free ends 140 emerge from the proximal end ofthe suture threader in the manner shown in FIG. 4. Suture 30 can remainin this position, with its distal loop 135 shielded within and carriedby shaft 110, as suture threader 25 is moved about. When suture 30 isthereafter advanced further down lumen 125, engagement of distal loop135 with transverse surface 130 causes distal loop 135 to be directedtransversely out of the shaft, in the manner shown in FIG. 5, so thatdistal loop 135 no longer sits substantially coaxial with thelongitudinal axis of shaft 110. Thus, engagement of distal loop 135 withtransverse surface 130 causes the distal loop to project laterally outof the distal end of shaft 110, whereby distal loop 135 can be “slippedover” a projecting finger 90 of anchor 15, as will hereinafter bediscussed in further detail.

Looking next at FIGS. 6-10, anchor system 5 is preferably used in thefollowing manner to attach suture to an anchor deployed in bone, wherebythe anchor and suture may be used to attach soft tissue to bone.

First, pilot drill 10 is used to form a pilot hole H in bone B (FIG. 6).Alternatively, hole H may be made by other means well known in the art,e.g., a sharp punch rod.

Next, driver 20 is used to screw anchor 15 into hole H in bone B (FIG.7). More particularly, driver 20 is inserted into bore 65 of anchor 15,and then driver 20 is used to turn anchor 15 into hole H. It should beappreciated that, as this occurs, driver 20 is inserted only a portionof the way down bore 65 in anchor 15, so that driver 20 does not enterhollow nose cone 70 of anchor 15 and so that fingers 90 of hollow nosecone 70 remain in their closed position (i.e., in the position shown inFIG. 2). After anchor 15 has been advanced an appropriate distance intohole H, driver 20 is withdrawn from anchor 15.

Next, suture threader 25 is used to attach a suture 30 to anchor 15while the anchor is disposed in bone hole H. More particularly, suture30 is positioned within suture threader 25 in the manner shown in FIG.4, i.e., so that distal loop 135 of suture 30 is disposed just proximalto transverse surface 130, then suture threader 25 is advanced down bonehole H and down bore 65 of anchor 15 until the distal end of suturethreader 25 extends through hollow nose cone 70 and spreads fingers 90open (FIG. 8), then suture 30 is advanced distally within lumen 125until distal loop 135 engages transverse surface 130 and is projectedlaterally out of the side of shaft 110 of suture threader 25 (FIG. 9),and then suture threader 25 is withdrawn proximally. As suture threader25 is withdrawn proximally, the laterally-projecting distal loop 135 ofsuture 30 is snared by one of the projecting fingers 90 of anchor 15.Further proximal movement of suture threader 25 allows resilient fingers90 of nose cone 70 to close, thereby locking distal loop 135 of suture30 over a finger 90, with distal loop 135 settling into circumferentialsurface groove 100 between two enlarged circular openings 95, in themanner shown in FIG. 10.

If desired, suture threader 25 can be configured so as to have a shaft110 with a circular cross-section. More preferably, however, shaft 110is provided with a cross-section which matches the cross-section of bore65 in anchor 15, so that the angular disposition of suture threader 25is coordinated with the angular disposition of anchor 15, whereby tofacilitate alignment of distal loop 135 of suture 30 with a finger 90 ofanchor 15. This arrangement helps ensure that distal loop 135 of suture30 engages a finger 90 of anchor 15 during retraction of the suturethreader from the anchor.

Significantly, if desired, additional sutures 30 may be attached toanchor 15 deployed in bone hole H, either on the same finger 90 or on adifferent finger 90, by repeating the foregoing procedure.

Thus it will be seen that suture anchor system 5 permits one or moresutures 30 to be attached to anchor 15 after the anchor has beendeployed in bone B. This is a significant advance in the art, sinceconventional suture anchors require that the suture be attached to thesuture anchor before the anchor is deployed in bone, thereby “freezing”the anchor/suture configuration prior to deployment of the anchor in thebone. Contrastingly, with the novel suture anchor system 5 of thepresent invention, the surgeon can deploy the anchor in the bone andthen attach one or more sutures to the anchor, as the surgeon desires,thereby permitting the surgeon to vary the anchor/suture configurationat any time during the procedure, including after the anchor has beendeployed in the bone. Thus, the surgeon can decide, mid-procedure, onthe number of sutures to be attached to the anchor.

Furthermore, where multiple anchors 15 are deployed in bone, the presentinvention permits a single suture 30 to be attached to multiple anchors.

Additionally, a repair construct can be formed using one or more anchors15 combined with other, dissimilar anchors of the sort known in the art.

Thus it will be seen that the present invention permits the surgeon toutilize a plurality of sutures and a plurality of anchors in a procedureand to determine, mid-procedure, precisely which sutures are to beattached to precisely which anchors.

In addition to the foregoing, as a consequence of the ability of thepresent invention to permit suture to be attached to the anchor afterthe anchor has been deployed in the bone, the suture can be attached tothe soft tissue either before the suture is attached to the anchor orafter the suture has been attached to the anchor.

Thus, the present invention provides the surgeon with tremendousflexibility when attaching soft tissue to bone, since it effectivelyallows the surgeon to treat the anchor and the one or more sutures asseparate components which may be married at any stage in the procedure,and with the ultimate anchor/suture configuration being variable at anystage in the procedure. This has not heretofore been possible with thesuture anchors of the prior art. See, for example, FIG. 37 which showsjust some of the many stitching patterns which may be created by passingone stitch through one anchor, one stitch through multiple anchors,multiple stitches through one anchor or multiple stitches throughmultiple anchors.

Significantly, suture anchor system 5 also permits knotless suturefixation to be effected. More particularly, and looking now at FIG. 11,after one or more sutures 30 have been attached to soft tissue and alsoattached to an anchor, and the sutures appropriately cinched, a plug 145may be forced down into the proximal end of bore 65 of the anchor,whereby to make an interference fit between plug 145 and anchor 15 andimmovably capture suture 30 to anchor 15. Thus, suture anchor system 5permits knotless suture fixation to be achieved. This is a significantadvance over prior art suture anchors.

Looking next at FIGS. 12-14, there is shown another anchor 200 alsoformed in accordance with the present invention. Anchor 200 generallycomprises a shaft 205 terminating in a pointed tip 210 and having screwthreads 215 thereon. Anchor 200 also comprises a head 220 having anaxial recess 225 formed therein. Axial recess 225 has a non-circular(e.g., ovoid) cross-section. A flexible crossbar 230 extends acrossaxial recess 225. More particularly, a flexible crossbar 230 comprises afixed end 235 which is secured to head 220 and a free end 240, wherebyto form a cantilever construction. Flexible crossbar 230 extends at atransverse angle to the longitudinal axis of anchor 200. Moreparticularly, flexible crossbar 230 descends distally as it extendsacross axial recess 225, in the manner shown in FIGS. 13 and 14, so thatflexible crossbar 230 has its free end 240 disposed distally of itsopposing fixed end 235. Head 220 of anchor 15 also comprises a crossbarwindow 245. The free end of flexible crossbar 230 extends into crossbarwindow 245 for reasons which will hereinafter be discussed. Head 220also comprises a pair of diametrically-opposed side windows 250.

Anchor 200 is intended to be screwed into bone by a driver 255 (FIGS. 15and 16). More particularly, driver 255 generally comprises a shaft 260having a non-circular (e.g., ovoid) cross-section. The cross section ofshaft 260 is coordinated with the cross-section of axial recess 225 inanchor 200 in order that driver 255 can be used to turn anchor 200,whereby to screw anchor 200 into bone. Driver 255 includes a slot 262for accommodating flexible crossbar 230 of anchor 200, as willhereinafter be discussed in further detail.

Looking next at FIG. 17, there is shown a suture threader 265 which maybe used in conjunction with anchor 200. Suture threader 265 generallycomprises a shaft 270 terminating in a distal tip 275. Shaft 270 is cutalong its distal end so as to produce a pair of parallel fingers 280,285 which are separated intermediate their length by a window 290.Preferably fingers 280, 285 re-converge distal to window 290 at aninterface 295. A surface groove 300 is formed in finger 280 forreceiving suture 30. Another surface groove 305 is formed in finger 285for receiving another portion of suture 30. An opening 310 in finger 280permits suture 30 to pass from surface groove 300 to surface groove 305.It will be appreciated that suture 30 will be configured in the form ofa distal loop in the region where suture 30 passes from surface groove300, through opening 310 and into surface groove 305, as willhereinafter be discussed below. At least finger 285, and preferablyfinger 280 as well, is formed out of a resilient material, such thatfinger 280 can spring toward and away from finger 285.

Anchor 200, driver 255 and suture threader 265 are preferably used asfollows. First, a pilot hole is preferably made in the bone which is toreceive anchor 200, although in some circumstances the pilot hole may beomitted. Then driver 255 is used to screw anchor 200 into the bone. Thisis done by advancing the distal end of driver 255 into axial recess 225of anchor 200, with flexible crossbar 230 received in slot 262 in driver255, and then turning driver 255 so as to screw anchor 200 into thebone.

If desired, a suture may be looped around flexible crossbar 230 prior toengagement of the driver with the anchor, and then the two free ends ofthe suture held at the same time that the handle of the driver isgrasped, whereby to ensure that the anchor is held to the driver as theanchor is introduced into the patient and then into the bone. The suturecan thereafter be left attached to the anchor for use in a subsequentrepair procedure or detached from the anchor and withdrawn from thesurgical site.

Next, suture threader 200, with suture 30 disposed thereon (i.e., seatedwithin surface groove 300, opening 310 and surface groove 305), isadvanced into axial recess 225 of anchor 200. As this occurs, andlooking now at FIGS. 18-20, the distal end of suture threader 265engages flexible crossbar 230 and, by virtue of this engagement, causesthe free end of flexible crossbar 230 to flex downwardly, “skidding”along the exterior surface of suture threader 265, until the free end offlexible crossbar 230 “pops” through window 290. This action providestactile feedback to the surgeon, confirming that flexible crossbar 230is seated in window 290. Thereafter, suture threader 265 is withdrawnproximally from axial recess 225 of anchor 200. As this occurs, fingers280 and 285 of suture threader 265 engage flexible crossbar 230, causingat least finger 285 to flex outward so as to permit flexible crossbar230 to pass by the bifurcated fingers 280, 285. However, as this occurs,flexible crossbar 230 catches suture loop 135 formed at the distal endof suture 30, causing suture 30 to be captured on anchor 200. In thisrespect it should be appreciated that by configuring the anchor so thatfree end 240 of flexible crossbar 230 is normally disposed withincrossbar window 245, any proximal motion of flexible crossbar 230 duringretraction of suture threader 265 is limited by its engagement with theproximal surface of crossbar window 245, thereby ensuring that suture 30remains engaged on flexible crossbar 230. Alternatively, if desired,crossbar window 245 can be replaced by another structure providing atransverse edge to limit proximal motion of flexible crossbar 230, e.g.,a transverse bar.

Significantly, side windows 250 formed in anchor 200 permit fluids topass from the interior of the bone through the anchor so as to reach thesoft tissue being re-attached to the bone. This can be advantageous,since such fluids are frequently rich in growth-promoting factors whichcan expedite soft tissue regrowth.

The foregoing procedure may thereafter be repeated as desired so as toattach additional lengths of suture to the deployed anchor 200.

Thus it will be seen that anchor 200, driver 255 and suture threader 265permit anchor 200 to be deployed in a bone and a suture to be thereafterattached to that anchor, so that soft tissue may be attached to the boneusing the anchor and suture.

If desired, and looking next at FIG. 21, a suture-binding plug may beinserted into the proximal end of anchor 200 so as to fix suture 30relative to the anchor. More particularly, in this form of theinvention, the plug may take the form of a cap 315 comprising a bridgeportion 320 and a pair of descending legs 325 each terminating in a barb330. Barbs 330 are intended to seat in side windows 250 of anchor 200,whereby to lock cap 315 to anchor 200, fixing suture 30 to anchor 200 inthe process.

If desired, cap 315 can include a longitudinal bore for passing suture30 therethrough. With this construction, cap 315 can be loaded onto thefree ends of suture 30 and then slid down the suture and into positionon the anchor. By interfacing cap 315 with the suture in this manner,cap 315 can be quickly and easily directed into its proper positionwithout the risk of becoming a loose element within the body.

Looking next at FIG. 22, the suture-binding plug may also take the formof a cap 315A which omits barbs 330, in which case legs 325 compressinto a lower portion of axial recess 225, with flexible crossbar 230securing bridge portion 320 to the anchor, and with bridge portion 320securing suture 30 to the anchor.

Looking next at FIGS. 23 and 24, there is shown still another anchor 335formed in accordance with the present invention. Anchor 335 generallycomprises a shaft 360 terminating in a pointed tip 365 and having screwthreads 370 thereon. Anchor 335 also comprises a head 375, at least partof which is formed by a plurality of upstanding spaced elements 380, andhaving an axial recess 385 formed therein. Axial recess 385 can have anon-circular (e.g., ovoid) cross-section so that it can be turned with adriver having a shaft with a non-circular (e.g., ovoid) cross-section,whereby to turn anchor 200 into bone. Alternatively, anchor 200 can beturned by a driver having a distal end having a counterpart dispositionto the plurality of upstanding spaced elements 380, whereby the drivercan turn the anchor. A plurality of flexible crossbars 390 extend acrossaxial recess 385. Flexible crossbars each comprise a fixed end 395secured to anchor 335 and a free end 400, whereby to form a cantileverconstruction. Flexible crossbars 390 extend at a transverse angle to thelongitudinal axis of anchor 335. More particularly, flexible crossbars390 descend distally as they extend across axial recess 385, in themanner shown in FIG. 23, so that flexible crossbars 390 have their freeends 400 disposed distally of their opposing fixed ends 395.

Looking next at FIGS. 25 and 26, there is shown a suture threader 405which may be used to attach a suture 30 to anchor 335. Suture threader405 comprises a hollow cannula having an interior lumen 410 and a slot415 formed in its distal end. A suture 30 may be threaded down interiorlumen 410, out slot 415 and then back alongside the exterior of thesuture threader, in the manner shown in FIGS. 25 and 26. As a result ofthe natural resiliency of suture 30, a portion of distal loop 135 ofsuture 30 will stand laterally displaced from the hollow cannula, suchthat it can be caught by one of the flexible crossbars 390.

FIG. 26A shows a suture threader 405A generally similar to suturethreader 405 shown in FIGS. 25 and 26, except that slot 415 is replacedby a hole 415A.

In use, and looking now at FIGS. 27-29, anchor 335 is screwed into thebone, and then a suture 30 is attached to anchor 335 using suturethreader 405. This is done by advancing the distal end of suturethreader 405 into axial recess 385 of anchor 335 until suture loop 135slips over free end 400 of a flexible crossbar 390. Then suture threader405 is retracted, leaving suture 30 attached to anchor 335.

Thus it will be seen that anchor 335 and suture threader 405 permitanchor 335 to be deployed in bone and a suture to be thereafter attachedto that anchor, so that soft tissue may be attached to the bore usingthe anchor and suture.

As discussed above, the screw threads of the various anchors disclosedabove serve to secure the anchor to the bone. However, it should also beappreciated that other mechanisms may be used to secure the body of theanchor to the bone. Thus, by way of example but not limitation, barbs,ribs, teeth and/or other anchor-securing mechanisms of the sort wellknown in the art may be incorporated on the body of the suture anchor soas to ensure that the suture anchor remains secured in the bone. Inaddition to the foregoing, other approaches can be used to secure thebody of the anchor in the bone, e.g., the body can be hammered into thebone like a nail, or the anchor can be toggled upon entry into the boneso as to prevent its withdrawal, etc.

It should also be appreciated that, for the aforementioned constructionsutilizing a flexible crossbar (e.g., anchors 200 and 335), alternativemeans may be provided for supporting the flexible crossbar on theanchor. Thus, by way of example but not limitation, and looking now atFIGS. 30-32, one or more flexible crossbars C may be supported on avertical post V (FIG. 30), one or more vertical crossbars C may beformed as part of a spring clip S (FIG. 31) and one or more verticalcrossbars C may be formed as part of a spring latch L (FIG. 32).

Furthermore, and looking now at FIG. 33, the crossbar need not beflexible, provided that the crossbar forms a tortuous pathway whichrestricts suture disengagement. Thus, for example, in FIG. 33, crossbarC is shown in the form of an eyelet having a restricted access point A.

Thus it will be seen that the suture may be attached to the anchor by avariety of means including a post, buckle, pulley, hook, spring,carabineer, latch or any other suture-receiving mechanism that iscapable of securing suture to the anchor at one or more points within oron the anchor.

Looking next at FIGS. 34-36, there is shown a suture threader 500 whichmay be used in conjunction with any of the anchors discussed above.Suture threader 500 generally comprises a shaft 505 terminating in adistal tip 510. Shaft 505 is cut along its distal end so as to produce apair of parallel fingers 515, 520 which are separated intermediate theirlength by a slot 525. A surface groove 530 is formed in finger 515 forreceiving suture 30. Another surface groove 535 is formed in finger 520for receiving another portion of suture 30. Suture seats 540 are formedat the distal ends of fingers 515, 520 so as to support suture 30 as itpasses from surface groove 530 to surface groove 535. Thus, it will beappreciated that suture 30 will be configured in a U-shape in the regionwhere suture 30 passes from surface groove 530 and into surface groove535. Suture threader 500 may be used to capture suture to an anchor inthe manner discussed above, e.g., by moving suture 30 distally so as toengage a crossbar and then moving the suture threader proximally so asto snare suture 30 on the crossbar.

Looking next at FIGS. 38-43, there is provided a suture 600 comprisingone or more suture loops 605 and one or more free ends 610. Suture loops605 may be interlocking or independent of one another.

Each of the free ends 610 may be passed through soft tissue and around arespective crossbar via a suture threader. The suture can then be pulledthrough the anchor such that the suture loop is disposed on either sideof the crossbar C of anchor A (FIG. 40). The ends of the suture loop canthen be cut to create two additional free ends of suture emanating fromthe anchor that can be used independently in the soft tissue repair(FIG. 41).

Looking next at FIG. 44, there is provided suture 615 comprising threefree, unencumbered ends 620. Each of the free ends 620 of suture 615 canbe pulled through an anchor such that multiple strands of suture aredisposed on either side of a crossbar. Suture 620 can then be used tothread one or more additional anchors in the same manner. Suture 620 canthen be cut at or near the intersection of the multiple suture strandssuch that two or more free ends of suture are emanating from the anchorthat can be used independently in the soft tissue repair.

These suture designs are applicable in situations in which the surgeonwould, absent these suture designs, otherwise have to pass suturethrough tissue multiple times to get more than one free end of sutureemanating from an anchor. These suture designs allow the surgeon to makeone pass through tissue and into an anchor and, by cutting the suture,have multiple free ends of suture to use independently in the softtissue repair.

Looking next at FIGS. 45-48, there is shown a soft tissue graspingmechanism 625 comprising a tip 630 and a shaft 635 which connects tip630 to a handle (not shown). Tip 630 comprises a top portion 640 and abottom portion 645. The handle is configured to open and close topportion 640 and bottom portion 645 so as to grasp tissue and clamp itbetween inner surface 650 of top portion 640 and inner surface 655 ofbottom portion 645. The handle is also configured to position topportion 640 and bottom portion 645 up or down so as to angle tip 630relative to shaft 635.

One or both of inner surfaces 650 and inner surface 655 may compriseteeth-like elements to enhance the grip on soft tissue when clampingsoft tissue between the top and bottom portions of tip 630. Tip 630 mayalso have fork-like tines extending therefrom for enhancing the grip onsoft tissue.

Preferably, the handle is ergonomically designed so as to allow asurgeon to comfortably grip soft tissue grasping mechanism 625.

Referring now to FIGS. 49-51, shown therein are several embodiments ofbone screws 700 a-700 e. The bone screws 700 may be employed to securerepair bones and to secure bone plates, surgical implants, andprosthesis. With reference to bone screw 700 a, bone screws 700generally comprise a shaft 705 terminating in a pointed tip 710 andhaving screw threads 715 thereon. Bone screw 700 also comprises a head720 having an axial recess 725 formed therein. Axial recess 725 has anon-circular (e.g., ovoid) cross-section. A flexible crossbar 730extends across axial recess 725. More particularly, a flexible crossbar730 comprises a fixed end 735 which is secured to shaft 705 and a freeend 740, whereby to form a cantilever construction. Flexible crossbar730 extends at a transverse angle to the longitudinal axis of anchor700. More particularly, flexible crossbar 730 descends distally as itextends across axial recess 725, in the manner shown in FIG. 50 so thatflexible crossbar 730 has its free end 740 disposed distally of itsopposing fixed end 735. The head or shaft of the bone screw 700 alsocomprises a crossbar window 745. The free end of flexible crossbar 730extends into crossbar window 745.

Referring now to FIGS. 52-56, a bone plate 800 construct in accordancewith the inventive concepts disclosed herein is illustrated. The boneplate 800 may be used for fixation of the long bones, such as, forexample, fixation of the proximal humerus. The bone plate 800 mayinclude a body 805 with an elongated shaft 810 with a length greaterthan its width and a head 815, preferably spoon-shaped, with a widthwhich is greater than the width of the elongated shaft 810. Theelongated shaft and the head may have a common longitudinal axis and maybe interconnected by a transition area. The transition area may widenfrom the width of the elongated shaft 810 to the width of the head 815

A plurality of screw holes 820 may be located in the elongated shaft andin the head. The screw holes 820 provided in the elongated shaft and thehead may be threaded on non-threaded.

The head 815 is shown to include a plurality of suture capture elements825. The suture capture elements 825 include a window 830 formed in thehead 815. A flexible crossbar 835 extends across the window. Moreparticularly, a flexible crossbar 835 comprises a fixed end 840 which issecured to the head 815 and a free end 845, whereby to form a cantileverconstruction. Flexible crossbar 835 extends at a transverse angle to thelongitudinal axis of the body 805 of the bone plate 800. Moreparticularly, flexible crossbar 835 descends distally as it extendsacross the window 830, in the manner shown in FIGS. 55 and 56 so thatflexible crossbar 835 has its free end disposed distally of its opposingfixed end. The body 805 further may have a recess 850 in which the freeend of the flexible cross bar 835 is disposed.

FIGS. 57-66 illustrate another version of a bone plate 800 a constructedin accordance with the inventive concepts disclosed herein. The boneplate 800 a is similar in construction to the bone plate 800 except asnoted below. In particular, the bone plate 800 a includes a plurality ofsuture capture elements 825 a. The suture capture elements 825 a includea window 830 a formed in the head. A rigid protrusion or peninsula 835 aextends inwardly into the window from a position proximate an edge ofthe head. More particularly, the protrusion 835 a comprises a fixed end840 a which is secured to the head 815 a and a free end 840 a. Theprotrusion 835 a extends at an angle to the longitudinal axis of plate800 a. More particularly, protrusion 835 a angle upwardly as it extendsfrom the edge of the head and into the window.

As shown in FIG. 61, the protrusion 835 a may include a hook element 855on its lower side to restrict sutures from slipping off the protrusion.

Moreover, the suture capture elements may further include a flexiblecrossbar 860 as illustrated in FIG. 62-66.

It should be understood that proximal humerus bone plates are used as anon-limiting example of how this technology may be employed. It shouldbe understood that this technology may be employed many places in whichsurgical implants are asked to engage surgical suture.

A benefit of the present technology is its impact on the surgicaltechnique. Plates enhanced with the suture capture elements describedherein enable a surgeon to pass his sutures completely through the softtissue before engaging the suture with the plate. This can beaccomplished by introducing the suture to the implant mid-strand bysimply folding the suture segment in half and creating a loop which issnagged by the nose of the peninsula. The surgeon is not required tothread the suture through the implant using its leading tip. Allowingthe surgeon to introduce the suture mid-strand enables him to avoidhaving the sharp point of the needle, which is fixed to the end of thesuture strand, from coming in contact with any suture already engagedwith the plate.

Additionally, this technology is designed such that a surgeon mayselectively remove a given segment of suture from the suture capturewindow by bringing both halves of said suture section to the same sideof the peninsula. In effect the suture will no longer be wrapped aroundthe peninsula and therefore can slide free from the suture capturewindow.

Referring to FIGS. 67-71, a suture may be secured in any hardwareenhanced with the current technology using a plug as described above.Another embodiment of a plug 900 is illustrated in FIGS. 67-69. In thisembodiment, a ribbed collar 905 is expanded within the lumen of thehardware thereby applying pressure to the suture and securing it inplace.

FIGS. 70-71 illustrate a device 920 used to deploy the plug 900 shown in67-69. This device 920 may be used to gather and tension the filamentsemanating from the current technology while at the same time deployingthe plug within the technology-enhanced hardware.

FIGS. 72-73 illustrate another embodiment of the filament threader 950.The filament may be captured by keyhole eyelets 955 in the distal end ofthe threader. The filament would then be spread between the two limbs960 of the threader, thereby creating a filament “bridge”. The threadercould be introduced into the technology-enhanced hardware, enabling thefilament to be captured.

It should be understood that many additional changes in the details,materials, steps and arrangements of parts, which have been hereindescribed and illustrated in order to explain the nature of the presentinvention, may be made by those skilled in the art while still remainingwithin the principles and scope of the invention.

What is claimed is:
 1. A bone plate, comprising: a body having an upperside, a lower side, a length, and a width, the length being greater thanthe width, the body having a window formed therein so as to extend fromthe upper side to the lower side and be encompassed entirely by the bodyand a plurality of holes extending through the body from the upper sideto the lower side for receiving bone screws, wherein the body has asuture capture element formed in the body for attaching at least onesuture to the plate, the suture capture element including at least onecrossbar extending from the body and into the window such that thecrossbar has a free end and a fixed end with the free end positioned onan opposing side of the window from the fixed end and the fixed endfixed to the body to prevent movement of the fixed end relative to thebody, the crossbar is flexible such that when a distally directed forceis applied to the crossbar, the free end of the crossbar is deflectedrelative to the fixed end of the crossbar and away from the body andwhen a proximally directed force is applied to the crossbar, the freeend of the crossbar directly contacts the body.
 2. A repair system,comprising: at least one suture; and at least one plate comprising abody with at least one window formed therein and a suture captureelement formed in the body for attaching at least one suture to theplate, the suture capture element comprising a rigid protrusionextending inwardly into the window in a way that the window isencompassed entirely by the body and the rigid protrusion, the rigidprotrusion having a proximal end fixed to the body to prevent movementof the proximal end relative to the body and a free end fixed relativeto the proximal end to permit the suture to be looped around and snaredby the suture capture element after the plate has been attached to bone,wherein the at least one suture is snared by the suture capture elementin a way that a portion of the suture is looped around the rigidprotrusion with the portion of the suture being disposed in the at leastone window and being in direct contact with the rigid protrusion betweenthe proximal end and the free end, wherein the suture capture elementfurther comprises at least one crossbar extending from the body and intothe window such that the crossbar has a free end and a fixed end withthe free end positioned on an opposing side of the window from the fixedend and on a lower side of the protrusion and the fixed end fixed to thebody to prevent movement of the fixed end relative to the body, whereinthe crossbar is flexible such that when a distally directed force isapplied to the crossbar, the free end of the crossbar is deflectedrelative to the fixed end of the crossbar and away from the lower sideof the protrusion and when a proximally directed force is applied to thecrossbar, the free end of the crossbar directly contacts the lower sideof the protrusion between the proximal end and the free end of theprotrusion, wherein the at least one suture is snared by the suturecapture element in a way that the portion of the suture disposed in thewindow is disposed distally of the crossbar.
 3. A bone plate,comprising: a body having an upper side, a lower side, a length, and awidth, the length being greater than the width, the body having a windowformed therein extending from the upper side to the lower side and aplurality of holes extending through the body from the upper side to thelower side for receiving bone screws, wherein the body has a suturecapture element formed in the body for attaching at least one suture tothe plate, the suture capture element including a rigid protrusionextending inwardly into the window in a way that the window isencompassed entirely by the body and the rigid protrusion, the rigidprotrusion having a proximal end fixed to the body to prevent movementof the proximal end relative to the body and a free end fixed relativeto the proximal end to permit the at least one suture to be loopedaround and snared by the capture element in a way that a portion of theat least one suture is disposed in the at least one window and in directcontact with the rigid protrusion between the proximal end and the freeend after the body has been attached to the bone with the lower side ofthe body in direct contact with the bone, wherein the suture captureelement further comprises at least one crossbar extending from the bodyand into the window such that the crossbar has a free end and a fixedend with the free end positioned on an opposing side of the window fromthe fixed end and on a lower side of the protrusion and the fixed endfixed to the body to prevent movement of the fixed end relative to thebody, wherein the crossbar is flexible such that when a distallydirected force is applied to the crossbar, the free end of the crossbaris deflected relative to the fixed end of the crossbar and away from thelower side of the protrusion and when a proximally directed force isapplied to the crossbar, the free end of the crossbar directly contactsthe lower side of the protrusion between the proximal end and the freeend of the protrusion.